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Gastrointest Endosc. 2011 Jul;74(1):65-73.e12. doi: 10.1016/j.gie.2011.01.072. Epub 2011 Apr 14.

Individual and practice differences among physicians who perform ERCP at varying frequency: a national survey.

Author information

1
Indiana University School of Medicine, Indianapolis, IN, USA. gcote@iupui.edu

Abstract

BACKGROUND:

ERCP practice patterns in the United States are largely unknown.

OBJECTIVE:

To characterize the ERCP practice of U.S. gastroenterologists, stratified by their annual case volume: high volume (HV, >200), moderate volume (MV, 50-200), and low volume (LV, <50).

DESIGN:

Anonymous electronic survey.

SUBJECTS:

American Society for Gastrointestinal Endoscopy members who are practicing U.S. gastroenterologists.

RESULTS:

Among all responders (N = 1006), 63% were derived from community practices. Physicians who performed ERCPs and provided data on annual volume (n = 669) were classified as LV (n = 254), MV (n = 284), and HV (n = 131). During training, 77% of LV physicians did not complete 180 ERCPs compared with 58% of MV and 34% of HV physicians (P < .0001). Only 58% of LV physicians enjoy performing ERCP compared with 88% of MV and 98% of HV physicians (P < .0001); 60% reported being "very comfortable" with ERCP compared with more than 90% of MV and HV physicians (P < .0001). LV physicians are less comfortable with pancreatic duct stenting (PDS) (57% vs 92% [MV] and 98% [HV], P ≤ .02) and using prophylactic PDS. Although HV physicians (42%) were least likely to use short-wire devices (P < .02), use of wire-guided cannulation was similar (74% LV, 72% MV, 66% HV, P = .13). Thirty-seven percent of LV physicians reported comfort with needle-knife sphincterotomy compared with 75% (MV) and 99% (HV) (P < .0001).

LIMITATIONS:

Survey completion rate of 18.5%.

CONCLUSIONS:

Self-reported comfort and/or enjoyment with ERCP is lower among LV physicians. Wire-guided cannulation is used by the majority of all ERCP practitioners, but prophylactic PDS is less frequently used by LV physicians. Because many LV physicians perform ERCP for higher-grade indications and use advanced techniques (eg, needle-knife sphincterotomy), further LV physician ERCP outcomes data are needed.

PMID:
21492851
DOI:
10.1016/j.gie.2011.01.072
[Indexed for MEDLINE]

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